PACKRAT EXAM QUESTIONS & ANSWERS
A 16 year old has just moved schools. He is quiet, moody and not like himself at all.
Within six months he seems to have completely changed back to his previous
personality. What is the most likely diagnosis? - Answers - Adjustment disorder
What is the prophylactic antibiotic most commonly given before a dental procedure if
one is necessary? - Answers - Amoxicillin 2 grams po 1 hour before procedure
Wilson's disease is associated with a build up of what mineral? - Answers - There is a
deficiency of the copper binding protein and therefore a buildup of copper.
Name one oral medication that can be used for MRSA. - Answers - Linezolid (Zyvox)
and Bactrim
Which cardiac medication is used to help with cardiac contractility after you have
optimized most of the other cardiac medications? - Answers - Digoxin
What medication used in hepatitis B infection helps prevent the need for liver
transplant? - Answers - Lamivudine
How is celiac disease most commonly diagnosed? - Answers - Endoscopic biopsy
Mononucleosis
A 14 year old field hockey player presents with prominent adenopathy, white purple
exudates in the throat and a palpable spleen. What is the most likely diagnosis? -
Answers - Wernicke's aphasia
List the four most common places lung cancer will metastasize to. - Answers - Bone,
brain, adrenals and liver
What is the main risk factor for esophagitis? - Answers - Immunocompromised patient
An EKG shows a regular rate of 50 beats per minute. The QRS is narrow and there is
no visible P wave. What is the most likely diagnosis? - Answers - Junctional rhythm
List two diagnoses which require antibiotic prophylaxis for "dirty procedures?" -
Answers - Prosthetic valve, valve repair with any prosthetic material, prior endocarditis
diagnosis, congential cyanotic heart defect
Does a patient with mitral valve prolapse require prophylactic antibiotics for dental
work? - Answers - No, a recent change moves mitral valve prolapse from high risk to
moderate risk.
A pregnant woman and cat litter should make you think of what diagnosis? - Answers -
Toxoplasmosis
,What two valvular issues do patients with Marfan's syndrome often have? - Answers -
Aortic regurgitation and mitral valve prolapse (you can tell them apart by where they are
heard).
What is the most common cause of sudden cardiac death? - Answers - Ventricular
fibrillation
A positive straight leg test indicates what diagnosis? - Answers - Herniated disc
What two psychiatric issues are more common in males than females? - Answers -
Autism and ADD, the rest are all either equal or more common in females.
How long must symptoms last before diagnosing ADD? - Answers - 6 months
What are the two most common organisms responsible for cellulitis? - Answers - Strep
and Staph
Does total lung capacity go up or down in COPD? What organism causes Lyme
disease? - Answers - It goes up.
What organism is most commonly responsible for community acquired pneumonia? -
Answers - Borrelia burgdorferi
An EEG showing focal rhythmic discharges at the onset of the seizure should make you
think of what diagnosis? - Answers - Strep pneumoniae
What is the normal range for MCV? - Answers - Simple partial seizure
A patient's lab work shows positive Smith antibody and positive double-stranded DNA
antibodies. What is the most likely diagnosis? - Answers - 80-100 Lupus
You hear a continuous machine-like murmur. What is the most likely diagnosis? -
Answers - Patent ductus arteriosus (PDA)
How do you administer the Weber hearing test? - Answers - Tuning fork placed in the
middle of the forehead
By what age should a child be able to kick a ball? - Answers - 24 months
A patient presents with what appears to be an inability to understand speech. Which
aphasia should be at the top of your differential? - Answers - It is blood in the joint
indicating a fracture even if the fracture line cannot be seen.
A fat pad sign on a lateral x-ray of the elbow has what significance? - Answers - It is
blood in the joint indicating a fracture even if the fracture line cannot be seen.
,A corkscrew appearance on barium study should make you think of what diagnosis? -
Answers - Esophageal spasms
What is the treatment for Turner's syndrome? - Answers - Cyclical estrogen and
progesterone
What is the gold standard for diagnosing myocarditis? - Answers - Myocardial biopsy
By what age should a child be able to hold up her head? - Answers - 3 months
On physical exam, you notice ulnar deviations and swan neck deformities. What is the
most likely diagnosis? - Answers - Rheumatoid arthritis
What is the most accurate way to diagnose urethritis? - Answers - Urine PCR
You hear a loud harsh holosystolic murmur in a child. It is heard best at the LLSB. What
is the most likely diagnosis? - Answers - Ventricular septal defect
The accessory pathway known as the James bundle should make you think of what
syndrome? - Answers - Lown-Ganong-Levine syndrome
A Blalock procedure is used to correct what congenital heart condition? - Answers -
Tetralogy of Fallot
What medication can be used to control bleeding due to uterine atony? - Answers -
Oxytocin (Pitocin)
What is the most common cause of a folate deficiency? - Answers - Alcoholism
List three risk factors for placental abruption. - Answers - HTN, smoking, AMA, cocaine
use, PROM
What ejection fraction is typical for a patient with CHF? - Answers - 35-40%
What is the major concern with using lithium? - Answers - It has a very narrow
therapeutic window. Blood tests are needed every four weeks.
A 6 year old boy seems to have all of the symptoms of ADD while at school, but at
home he has no problems. Does he have ADD? - Answers - No, symptoms must occur
in both settings for diagnosis.
Duchenne's and Becker's muscular dystrophy have what genetic characteristic? -
Answers - X-linked recessive
, Why is folic acid given as a prenatal vitamin? - Answers - Low folic acid can lead to
neural tube defects.
Color blindness is transmitted through what genetic pattern? - Answers - Dominant X-
linked
A patient presents with facial paresis, arm drift and abnormal speech. What are the first
three tests to order? - Answers - Thinking of a stroke you order a non-contrast brain
CT or MRI, serum glucose and oxygen saturation.
List 4 risk factors for endometrial cancer. - Answers - Chronic unopposed estrogen,
nulliparity, early menarche, late menopause, tamoxifen, DM, obesity, HTN, breast CA,
ovarian CA
Tall peaked P waves should make you think of what diagnosis? - Answers - Right atrial
enlargement
What is the best test to check for H. pylori? - Answers - Urea breath test
What it is the recommended treatment for hepatitis C infection? - Answers - Pegylated
interferon alpha-2
Is a nulliparous or mulitparous woman more likely to get preeclampsia? - Answers -
Nulliparity is a risk factor for preeclampsia.
Name the condition in which the head of the penis curves downward or upward, at the
junction of the head and shaft of the penis. (Hint: It is often associated with
hypospadias.) - Answers - Chordee
Acute sinusitis is most commonly caused by which two pathogens? - Answers - Strep
pneumoniae and haemophilus influenzae
A physical exam finding of egophony should make you think of what diagonsis? -
Answers - Lobar pneumonia
A patient presents with erectile dysfunction and complains of some numbness in his
feet. On second thought he has noticed significant polyuria and polydipsia. What
diagnosis should you be thinking of? - Answers - Diabetic neuropathy
What percentage of diabetes in the US is type 2? - Answers - 80-90%
What is the treatment for pneumocystis jiroveci pneumonia? - Answers - Bactrim
What will the bowel sounds be early on in a small bowel obstruction? What will they be
later on? - Answers - Early they are hyperactive. Late they are absent.
A 16 year old has just moved schools. He is quiet, moody and not like himself at all.
Within six months he seems to have completely changed back to his previous
personality. What is the most likely diagnosis? - Answers - Adjustment disorder
What is the prophylactic antibiotic most commonly given before a dental procedure if
one is necessary? - Answers - Amoxicillin 2 grams po 1 hour before procedure
Wilson's disease is associated with a build up of what mineral? - Answers - There is a
deficiency of the copper binding protein and therefore a buildup of copper.
Name one oral medication that can be used for MRSA. - Answers - Linezolid (Zyvox)
and Bactrim
Which cardiac medication is used to help with cardiac contractility after you have
optimized most of the other cardiac medications? - Answers - Digoxin
What medication used in hepatitis B infection helps prevent the need for liver
transplant? - Answers - Lamivudine
How is celiac disease most commonly diagnosed? - Answers - Endoscopic biopsy
Mononucleosis
A 14 year old field hockey player presents with prominent adenopathy, white purple
exudates in the throat and a palpable spleen. What is the most likely diagnosis? -
Answers - Wernicke's aphasia
List the four most common places lung cancer will metastasize to. - Answers - Bone,
brain, adrenals and liver
What is the main risk factor for esophagitis? - Answers - Immunocompromised patient
An EKG shows a regular rate of 50 beats per minute. The QRS is narrow and there is
no visible P wave. What is the most likely diagnosis? - Answers - Junctional rhythm
List two diagnoses which require antibiotic prophylaxis for "dirty procedures?" -
Answers - Prosthetic valve, valve repair with any prosthetic material, prior endocarditis
diagnosis, congential cyanotic heart defect
Does a patient with mitral valve prolapse require prophylactic antibiotics for dental
work? - Answers - No, a recent change moves mitral valve prolapse from high risk to
moderate risk.
A pregnant woman and cat litter should make you think of what diagnosis? - Answers -
Toxoplasmosis
,What two valvular issues do patients with Marfan's syndrome often have? - Answers -
Aortic regurgitation and mitral valve prolapse (you can tell them apart by where they are
heard).
What is the most common cause of sudden cardiac death? - Answers - Ventricular
fibrillation
A positive straight leg test indicates what diagnosis? - Answers - Herniated disc
What two psychiatric issues are more common in males than females? - Answers -
Autism and ADD, the rest are all either equal or more common in females.
How long must symptoms last before diagnosing ADD? - Answers - 6 months
What are the two most common organisms responsible for cellulitis? - Answers - Strep
and Staph
Does total lung capacity go up or down in COPD? What organism causes Lyme
disease? - Answers - It goes up.
What organism is most commonly responsible for community acquired pneumonia? -
Answers - Borrelia burgdorferi
An EEG showing focal rhythmic discharges at the onset of the seizure should make you
think of what diagnosis? - Answers - Strep pneumoniae
What is the normal range for MCV? - Answers - Simple partial seizure
A patient's lab work shows positive Smith antibody and positive double-stranded DNA
antibodies. What is the most likely diagnosis? - Answers - 80-100 Lupus
You hear a continuous machine-like murmur. What is the most likely diagnosis? -
Answers - Patent ductus arteriosus (PDA)
How do you administer the Weber hearing test? - Answers - Tuning fork placed in the
middle of the forehead
By what age should a child be able to kick a ball? - Answers - 24 months
A patient presents with what appears to be an inability to understand speech. Which
aphasia should be at the top of your differential? - Answers - It is blood in the joint
indicating a fracture even if the fracture line cannot be seen.
A fat pad sign on a lateral x-ray of the elbow has what significance? - Answers - It is
blood in the joint indicating a fracture even if the fracture line cannot be seen.
,A corkscrew appearance on barium study should make you think of what diagnosis? -
Answers - Esophageal spasms
What is the treatment for Turner's syndrome? - Answers - Cyclical estrogen and
progesterone
What is the gold standard for diagnosing myocarditis? - Answers - Myocardial biopsy
By what age should a child be able to hold up her head? - Answers - 3 months
On physical exam, you notice ulnar deviations and swan neck deformities. What is the
most likely diagnosis? - Answers - Rheumatoid arthritis
What is the most accurate way to diagnose urethritis? - Answers - Urine PCR
You hear a loud harsh holosystolic murmur in a child. It is heard best at the LLSB. What
is the most likely diagnosis? - Answers - Ventricular septal defect
The accessory pathway known as the James bundle should make you think of what
syndrome? - Answers - Lown-Ganong-Levine syndrome
A Blalock procedure is used to correct what congenital heart condition? - Answers -
Tetralogy of Fallot
What medication can be used to control bleeding due to uterine atony? - Answers -
Oxytocin (Pitocin)
What is the most common cause of a folate deficiency? - Answers - Alcoholism
List three risk factors for placental abruption. - Answers - HTN, smoking, AMA, cocaine
use, PROM
What ejection fraction is typical for a patient with CHF? - Answers - 35-40%
What is the major concern with using lithium? - Answers - It has a very narrow
therapeutic window. Blood tests are needed every four weeks.
A 6 year old boy seems to have all of the symptoms of ADD while at school, but at
home he has no problems. Does he have ADD? - Answers - No, symptoms must occur
in both settings for diagnosis.
Duchenne's and Becker's muscular dystrophy have what genetic characteristic? -
Answers - X-linked recessive
, Why is folic acid given as a prenatal vitamin? - Answers - Low folic acid can lead to
neural tube defects.
Color blindness is transmitted through what genetic pattern? - Answers - Dominant X-
linked
A patient presents with facial paresis, arm drift and abnormal speech. What are the first
three tests to order? - Answers - Thinking of a stroke you order a non-contrast brain
CT or MRI, serum glucose and oxygen saturation.
List 4 risk factors for endometrial cancer. - Answers - Chronic unopposed estrogen,
nulliparity, early menarche, late menopause, tamoxifen, DM, obesity, HTN, breast CA,
ovarian CA
Tall peaked P waves should make you think of what diagnosis? - Answers - Right atrial
enlargement
What is the best test to check for H. pylori? - Answers - Urea breath test
What it is the recommended treatment for hepatitis C infection? - Answers - Pegylated
interferon alpha-2
Is a nulliparous or mulitparous woman more likely to get preeclampsia? - Answers -
Nulliparity is a risk factor for preeclampsia.
Name the condition in which the head of the penis curves downward or upward, at the
junction of the head and shaft of the penis. (Hint: It is often associated with
hypospadias.) - Answers - Chordee
Acute sinusitis is most commonly caused by which two pathogens? - Answers - Strep
pneumoniae and haemophilus influenzae
A physical exam finding of egophony should make you think of what diagonsis? -
Answers - Lobar pneumonia
A patient presents with erectile dysfunction and complains of some numbness in his
feet. On second thought he has noticed significant polyuria and polydipsia. What
diagnosis should you be thinking of? - Answers - Diabetic neuropathy
What percentage of diabetes in the US is type 2? - Answers - 80-90%
What is the treatment for pneumocystis jiroveci pneumonia? - Answers - Bactrim
What will the bowel sounds be early on in a small bowel obstruction? What will they be
later on? - Answers - Early they are hyperactive. Late they are absent.
